Australia, Indonesia, modernity and breastfeeding
Australia, Indonesia, modernity and breastfeeding
By Alison and Rob Goodfellow
NEW SOUTH WALES, Australia (JP): In the past, many people
innocently believed that among the blessings of modern science
was a recipe for infant formula so close to mother's milk that
the two were almost indistinguishable. Many mothers now know
differently.
In Australia, for example, particularly during the years
between 1950 and 1980, many women believed that the artificial
alternative to breast feeding presented no real risks. It was
maintained that as long as the formula was correctly prepared and
was uncontaminated then there was no cause for concern. This was
untrue. Significant nutritional and immunological differences
exist between breast milk and milk formula.
Various claims that formula is close in consistency to
mother's milk stretch the truth. First of all, all formulas
differ. Some have similar protein levels to breast milk, others
have similar quantities of essential minerals. However, none ever
come close to being able to adequately represent the dynamic
qualities of breast milk.
Colostrum, the first milk produced before and after birth is
full of living cells. Eighty percent to 100 percent of cells in
colostrum are phagocytes, which ingest yeast cells. (These cause
conditions such as thrush). As well as this, mother's milk
contains many basic antibodies that are bacteriostatic for a
number of dangerous microorganisms. Breast milk protects against
Escheriocha-coli, Vibrocholerae and Enterovirus, all of which can
cause severe infections in the newborn. Breast milk also protects
the baby from diarrhea.
Because all mothers are constantly exposed to pathogens in
their respective environments, a particular woman will produce
specific antibodies which are then passed on to her infant
through breast milk. This can provide up to one year's immuno-
protection for the child. There is no possibility that a
manufacturing process could ever tailor make a milk to satisfy
the different demands of each infant.
The composition of mother's milk changes from day to day and
mother to mother. Breast milk is able to meet the individual
needs of each infant. Even during feeding, the composition of the
milk can change. If a baby suckles strongly, as big babies do,
then there will be more fats in the milk. Or if a mother is
malnourished the amount of milk will be diminished but there will
still be adequate fat and protein available to the baby.
Compare this with a poor mother in either a developing nation,
or for that matter a developed one. Because poor mothers cannot
afford to buy formula they often make the tin last longer by
making weak mixes. This results in a malnourished child. It is
important to reinforce the fact that children actually die of
starvation this way. When we see pictures of women in famine
stricken nations breast feeding, the breast looks shrunken and
empty. However it is not until after weaning that starvation
syndromes begin to emerge in the child.
Significantly, in the newborn period, and throughout infancy
and early childhood, maximum growth occurs in brain tissue.
Mothers who have preterm infants (that is born before 36 weeks)
secrete milk which is different in composition to that of a
mother with a full term infant. Recent studies have shown that
human milk plays an important role in the intellectual
development biology of the newborn. Interestingly, in 1960,
breast feeding was at an all time low in the United States.
Significantly, in the same year, the measurable national U.S.
I.Q. level also dropped to a record low.
The metabolic response (the way the whole body operates) to
feeding is different in breast fed, as compared to formula fed
infants. These differences are attributed to the presence of
growth factors, human hormones and other biological substances
present in human milk. A correct balance of nutrients and other
mechanisms governing their use is crucial during the period of
rapid brain growth. This applies to even seemingly minor
components of breast milk.
Between March 1978 and August 1979 it was found that two soya
based formulae marketed in the United States and in Spain were
deficient in chloride. Babies fed on this formula developed
symptoms of chloride deficiency which include, failure to thrive,
anorexia, lethargy and metabolic alkalosis with low levels of
serum potassium. When these children were assessed four to five
years later they were found to have a number of serious
abnormalities.
One of these was a distinctive syndrome of cognitive
impairment, language disorders, visual and fine motor
difficulties, as well as a marked attention deficit syndrome.
This occurred because, at that time, there was some controversy
about salt and the association with heart disease. So formula
companies thought they were doing the right thing by reducing
salt (chloride) in their formulas. This is just one example of
the type of mishap that can be caused by juggling the different
nutrient balances of formula to try and match breast milk.
Before the 1960s, western babies were often fed on a variety
of different types of whole milk. For example, dried, evaporated,
and condensed milk. While none of these can compare with the
complicated formulae of today, results from their particular
inadequacies further reinforce the danger of the artificial
alternative. These included high morbidity and mortality from
infection, malnutrition, brain damage and anemia. More specific
problems included low levels of folic acid and vitamin C, which
caused megoblastic anemia.
There were also problems such as fits, cerebral palsy and
mental retardation caused by formulas being deficient in
pyridoxine (a type of B vitamin). Excessive protein in formula
was responsible for dehydration, uremia and brain damage. Other
maladies included scurvy, skin disorders, eye disorders, failure
to thrive and diarrhea.
At the time, all of these were obvious problems, which were
recognized quickly. However, formula companies still took too
long in modifying their product. Perhaps it was because there
were no regulations to monitor defective formula and no legal
backlashes to impede domestic and foreign sales.
Between the 1970s and 1980s other problems arose as formula
companies further modified their product with often disastrous
results. Minchin in her book, Breastfeeding Matters, lists
maladies such as bowel obstruction in preterm infants caused by
indigestible curds in the milk and fits from low levels of
calcium. There was also frequent reports of contamination from
lead and other heavy metals contained in the liner of formula
tins. There were numerous product re-calls during this time
because formula was curdled, discolored, smelt or just looked
"off". These problems were not just recognized in and isolated to
affluent countries. India, unfortunately, imported a western
manufactured formula which contained high copper levels. This
"error" caused severe liver disease in thousands of otherwise
healthy Indian infants.
In addition to these issues, questions still need to be asked
about diseases that develop in later childhood and even adulthood
and whether these are related to a family history of artificial
feeding. Why, for instance, is it that the chance for a
successful kidney transplant is higher if the patient was breast
fed. What other long term immunological effects may be uncovered?
One question that could be asked in relation to multiple
sclerosis is, what relationship exists between the low levels of
fat in formula and the development of de-myelination disorders.
At this point, all this information should be put into a
global perspective. More babies die from diarrhea every two and a
half days than have ever have died from the AIDS virus. In the
third world, diarrhea is directly exacerbated by bottle feeding
because there is often no readily available source of clean
water, because sterilizing techniques for bottles and teats are
inadequate and because fuel to boil water is in short supply.
Milk is an excellent medium for bacteria to multiply in. In hot
climates this happens very quickly.
However, it is important to remember that dehydration in
babies is not just a third world problem. Studies in Australia
have shown that in every level of society there are findings of
incorrectly made formula and the associated problems like those
already mentioned. The important issue then is that, regardless
of the source of powder or scoop design, the basic method is
incapable of delivering feeds with the necessary degree of
accuracy. It could be concluded then that there is little point
in manufacturers producing more advanced formula with specific
levels of minerals and vitamins if the method of reconstitution
is inherently inaccurate.
The other inherent problem with formula is, as already
mentioned, cost. It may come as a surprise to many Indonesians
that even in so-called "rich nations" there is an underclass
living in desperate poverty. For some Australians this makes
breast feeding a matter of infant life or death. Infant mortality
rates from Australian Aborigines reflect this serious problem.
And while it is now accepted by health workers that poverty is
the greatest enemy of children, the good news is that the health
of Australian children has improved with an increase in breast
feeding.
If you add to these issues the fact that, ecologically, bottle
feeding has a negative effect on the environment as opposed to
breast feeding, then you can begin to appreciate the scope of the
problem. Breast milk is a natural renewable source, which is
intended to be fed to babies, while artificial feeds are
processed, non-renewable substitutes. There is no waste from
breast milk as it works on a supply and demand method of
production. This can be compared to artificial milk that creates
a demand, then supplies for a price. Breast milk production does
not pollute. It is free and requires no packaging. Finally, of
great significance to women themselves, is the fact that breast
feeding significantly reduces the chances of the mother
developing breast cancer (which now affects one in eight
Australian women).
The eminent nutritionist Vahlquist wrote in 1976, "Obviously
new discoveries have widened the gap between human milk and even
the most ambitious and sophisticated of formula. No doubt the
artificial feeding industry will make every effort to produce a
new formula which comes ever closer to human milk, at least
superficially. But attempts to bridge the gap will remain futile
since we are a dealing here with such complex systems and such
species-specific substances that even the most costly substitute
cannot be foreseen to reach the ideal model. Thus new discoveries
in the field of the 'species-specificity' of human milk will
serve to underline very strongly the uniqueness and biological
superiority of this product of nature."
Clearly the Indonesian government has a good appreciation of
the importance of these issues. In his 1991 Presidential Decree,
President Soeharto strongly encouraged Indonesian women to breast
feed. And while many Indonesian women continue to believe that
bottle feeding is somehow superior, Australian women are
increasingly discovering that to raise a healthy, happy and
intelligent breast fed baby is truly an expression of a "modern
society".
Alison Goodfellow is a clinical liaison midwife with the
Illawarra Regional Hospital, Wollongong, NSW, Australia and The
Charles Stuart University. Her husband, Rob Goodfellow, is a
frequent contributor to The Jakarta Post.